Jackson Hudin N, Hamre Thomas, Bauer David F
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Baylor College of Medicine, Houston, Texas.
J Neurosurg Case Lessons. 2025 Aug 18;10(7). doi: 10.3171/CASE25267.
Sacropelvic fixation is used in the management of deformity, neoplasms, and fractures. S2-alar-iliac (S2AI) screws have evolved as a technique for sacropelvic fixation to address disadvantages associated with traditional iliac screws. In select patients, S2AI screw placement is not feasible due to patient anatomy, trauma, or osteolytic lesions.
A 15-year-old girl presented with a 3-month history of right S1-2 radicular pain and right dorsiflexion and plantar flexion weakness. Imaging revealed a right sacral alar aneurysmal bone cyst. The patient underwent right S1-3 hemilaminectomies and partial resection of the S2 and S3 vertebral bodies. Following adequate bony decompression, tumor debulking was performed. Bilateral L4-S1 pedicle screws and left S2AI screws were then placed using neuronavigation guidance. Due to right S1-2 sacral resection, S2AI screw placement was unfeasible. Right-S3 alar-iliac (S3AI) screw placement was performed, and good sacropelvic fixation was demonstrated. Herein, the authors describe the first clinical application of S3AI screw placement in a pediatric patient. After surgery, the patient experienced an improvement in symptoms before later tumor recurrence, which required adjuvant therapy. Long term follow-up revealed solid fusion with stable spinal alignment.
In select patients in whom S2AI screw placement is not an option, S3AI screw placement is a feasible, safe, alternative for sacropelvic fixation. https://thejns.org/doi/10.3171/CASE25267.
骶骨盆固定用于治疗畸形、肿瘤和骨折。S2 翼髂螺钉（S2AI）已发展成为一种骶骨盆固定技术，以解决传统髂骨螺钉相关的缺点。在特定患者中，由于患者解剖结构、创伤或溶骨性病变，S2AI 螺钉置入不可行。
一名 15 岁女孩出现右侧 S1-2 神经根性疼痛 3 个月，伴有右侧背屈和跖屈无力。影像学检查显示右侧骶骨翼动脉瘤样骨囊肿。患者接受了右侧 S1-3 半椎板切除术及 S2 和 S3 椎体部分切除术。在充分的骨质减压后，进行了肿瘤减瘤。然后在神经导航引导下置入双侧 L4-S1 椎弓根螺钉和左侧 S2AI 螺钉。由于右侧 S1-2 骶骨切除，S2AI 螺钉置入不可行。遂进行右侧 S3 翼髂（S3AI）螺钉置入，并显示出良好的骶骨盆固定效果。在此，作者描述了 S3AI 螺钉置入在儿科患者中的首例临床应用。术后患者症状改善，随后肿瘤复发，需要辅助治疗。长期随访显示融合牢固，脊柱排列稳定。
在 S2AI 螺钉置入不可行的特定患者中，S3AI 螺钉置入是一种可行、安全的骶骨盆固定替代方法。https://thejns.org/doi/10.3171/CASE25267。
